个体化肺保护通气对老年患者腹腔镜胃癌根治术后早期认知功能的影响  

作　　者：周建伟[1] 王传光[1] 王武[1] 徐宏涛[1] 高丽娟[1] 黄燕 郑芳 尧银光[1] 

机构地区：[1]浙江省丽水市中心医院,323000

出　　处：《浙江临床医学》2021年第10期1444-1446,共3页Zhejiang Clinical Medical Journal

基　　金：丽水市高层次人才培养资助项目(2019KC03)。

摘　　要：目的探讨个体化肺保护通气对老年患者腹腔镜胃癌根治术后早期认知功能(POCD)的影响。方法86例行腹腔镜胃癌根治术的老年胃癌患者按照随机数字表法分为对照组和观察组,每组各43例。观察组患者术中采用个体化肺保护通气方案,比较诱导前15 min(TO)、术中1 h(T1)、术后1天(T2)及术后3天(T3)两组的桡动脉和颈内静脉血气分析结果、脑动静脉氧含量差(Ca-jvDO_(2))、血管内皮生长因子(VEGF)水平和认知功能MMSE评分。结果与对照组比较,观察组T2、T3的氧合指数均显著提高,观察组T2的Ca-jvDO_(2)、Jlac均显著降低。观察组T2的MMSE评分为(22.7±1.7)分,对照组为(20.7±1.8)分,差异有统计学意义(P<0.05)。结论个体化肺保护通气可降低老年胃癌患者腹腔镜胃癌根治术后POCD的发生风险。Objective To explore the effect of individualized pulmonary protective ventilation on early postoperative cognitive function(POCD)in elderly patients of laparoscopic radical gastrectomy for gastric carcinoma.Methods 86 elderly patients with gastric cancer undergoing laparoscopic radical gastrectomy were divided into control group and observation group according to random number table method,with 43 cases in each group.Observation group was treated with individualized lung protective ventilation scheme during operation.The results of radial artery and internal jugular vein blood gas analysis,cerebral arteriovenous oxygen difference(Ca-jvDO_(2)),vascular endothelial growth factor(VEGF)level and cognitive function MMSE score were compared between the two groups 15 niin before induction(TO),1 h during operation(T1),1 day after operation(T2)and 3 days after operation(T3).Results Compared with the control group,the oxygenation index of T2 and T3 in the observation group was significantly increased,and the Ca-jvDO_(2) and Jlac in the observation group T2 were significantly decreased.The MMSE score of T2 in the observation group was(22.7±1.7)points,and that in the control group was(20.7±1.8)points,and the difference was statistically significant(P<0.05).Conclusion Individualized lung protective ventilation can reduce the risk of POCD in elderly patients with gastric cancer after laparoscopic radical gastrectomy.

关 键 词：术后认知功能障碍 血管内皮生长因子 肺动态顺应性 肺保护通气 

分 类 号：R73[医药卫生—肿瘤]